Joint Declaration by the member and the employer

Date:

To,
The Regional P.F. Commissioner,
341, Bhavishya Nidhi Bhavan,
Bandra (East),
Mumbai: 400 051.

Subject: - Joint Declaration by the member and the employer UAN:101435291421

Dear Sir,

I kochera deepthi bearing PF account No.MH/BAN/………./……… is an employee of Kotak

Mahindhra Bank trying to reset password. But the mobile number which was earlier used for
activation is not in use now. I tried to update new mobile number but my Aadhaar is not linked
with UAN. I am furnishing herewith below correct details with aforesaid establishment.

Particulars Correct Record Wrong Record

Name of Member KOCHERA DEEPTHI KOCHERA DEEPTI
Name of Father KOCHERA BABU RAO
Date of Birth 04/11/1993
Gender FEMALE
Relation FATHER
Aadhaar No 845433278723
I am enclosing herewith self-attested copy of Pan Card & Aadhar Card for your reference.

Therefore, you are requested to make necessary changes in your records under intimation to
me. So that I can reset the password. An early action in this regard will be highly appreciated.

Yours Faithfully

Name of applicant : KOCHERA DEEPTHI

Signature of applicant :

Name of Authorized Signatory:

Signature with Establishment Seal: